There was no argument to the idea that health care in Brockton was in need of attention. Statistics made it evident. The Federal Government declared that seven continuous census tracts in Brockton made up a Medically Underserved Area (MUA). This meant that within this area, the medical needs of the population were not being met. This MUA is composed of the downtown area from Oak Street to Nilsson Street. The birth rate of women in the age category of 15-19 in Brockton from 1985-1990 was 66 births for every 1,000 women. This figure was double the statewide rate of 33 births for every 1,000 women at that time. In addition to having a high teen pregnancy rate, the Department of Public Health designated Brockton as one of the three cities in Massachusetts that does not provide adequate prenatal care for teens. In the same age group (15-19), adequate pre-natal care was only administered for 37% of the pregnancies. Statewide, pre-natal care was administered for 53% of the cases. Given these facts, the infant mortality rate in this area may not seem surprising. From 1985-1990, 100 infants died before the age of one in Brockton. Ninety-four of these deaths occurred in the Medically Underserved Area. The overall infant mortality rate in this area was 26.5 deaths for every 1,000 births. This is considerably higher than the state average of 6.9 deaths for every 1,000 births. For all of these reasons, the health of pregnant women and infants was a target issue in Brockton.

Also, in considering the population that comprises the Medically Underserved Area, 10% of the residents are elderly. Generally, senior citizens have many medical needs to be met. The 2,403 senior citizens residing in the Medically Underserved Area were presumably not receiving the medical attention which they needed.

Another issue prominent in the Medically Underserved Area that presumably could have been inhibiting medical services is the issue of linguistics. Brockton on the whole has an extremely diverse population. Many Brockton residents are recent immigrants from Cape Verde, Haiti, Puerto Rico, etc. Immigration has given rise to a non-Eng1ish speaking portion of the population, as is the case in Brockton. Not only is medical service hindered by inability to communicate. There is also the issue of - comfort with health care. For example, an elderly Puerto Rican woman who is able to speak English sufficiently would probably make more use of the local medical services if the staff could communicate to her in her native language. Instances such as these prove that linguistic and cultural diversity acts as a barrier when the goal of the government is to tend to the medical needs of every person.

Correlating to each of these issues is the fact that 15.535% of the families in the Medically Underserved Area lived in poverty. This shows that there was an economic hindrance that prevented proper medical attention within this area. To get an idea of just how underserved this area of Brockton was, for a population of 26,551 residents, there were only 3 full- time physicians who provided primary and preventive health care. Along with the poverty revel of Brockton, the unemployment rate is also a problem. In fact, nationally, during the 1980s there was an economic decline which resulted.in the loss of jobs in significant numbers. This, in turn, increased the number of uninsured and underinsured individuals and families. This is an example of how nationwide dilemmas can be observed in Brockton. Since the uninsured and underinsured people either do not seek health services, or rely on free clinics and the emergency room, the alarming medical statistics previously discussed have been made possible.

Once the federal government and the Department of Public Health expressed concerns about the medical situation in Brockton by declaring the area Medically Underserved, Mayor Carl Pitaro took action. He called for the formation of a Task Force on Health and Human Services to include various agencies within the community. This Task Force was to investigate the circumstances and the reasons behind the medical statistics and then present a proposal in order to remedy the situation. The Task Force found that other surrounding communities had already found the solution to be a community-based health center. The recommendation for a community- based health center was formally announced in March of 1991. The concept of a community-based/neighborhood health center was originally developed .as a part of the Great Society of Lyndon B. Johnson in 1964. This Great Society focused on national improvements through targeting individual cities and towns. Specifically, the Great Society called for the improvement of education, welfare, and health care of urban areas in need of attention. Nationwide, a portion of the population was being medically isolated and deprived of health care. This portion included the unemployed, uninsured, homeless, and the culturally/ethnically diverse. This portion was growing. Basic health care needed to be extended to include everyone. If primary and preventive health care were an inclusive entity of American life, it was predicted that disease and increasing death rates would be challenged as well. This is the basis of the health care reform that has become one of the largest political platforms in the past decade.

One of the first neighborhood health centers was established in Dorchester, Massachusetts in the late 1960’s at Columbia Point. This clinic provided health care services, such as immunizations, to anyone, regardless of their ability to pay, medical status, or culture/ethnicity. Currently, the mission of the Massachusetts League of Community Health Centers is to .provide accessible, high quality primary health care to an entire community. This mission differentiates a community health center from any hospital that accepts any patients. These health centers pride themselves on quality health care so that the same medical services are offered to the uninsured that are offered to the insured. This quality includes primary care physicians available to the public. When a patient is able to see the same physician for every visit, a relationship develops based on trust and concern for the patient’s medical status. In surveys conducted for the past ten years about health care issues in Massachusetts, residents say that the quality of health care is the biggest factor’ in reviewing Massachusetts medical facilities. It is hypothesized by the Massachusetts Medical Society that “improved quality can reduce costs, particularly costs due to overuse and misuse of services.” Therefore, the purpose of community health centers is to improve the proper usage of basic health care by offering primary and preventive services to all members of the community.

Nationally, this type of center was the perfect remedy to some of the health care issues. Federal and State funds have been set aside for the establishment of community health centers in all neighborhoods that display a need for revisions to medical services. With one of the first community health centers, the branches of these clinics in Massachusetts sprang up quickly. The Uncompensated Care Pool was established in 1985 to provide access to health care for low income, uninsured and underinsured residents of Massachusetts by paying for free care services provided by hospitals and community health centers. It is through this system of financing that community-based health centers are able to offer the quality medical services that they do. In 1996, the Massachusetts Uncompensated Care Pool paid for about I .5 million outpatient visits to clinics. Most of the people who benefit from this Pool are young adults (18-44) with incomes under 133% of the Federal Poverty Guidelines. The extensive use of this Uncompensated Care Pool demonstrates how Massachusetts has acted in response to serious health care problems in recent years.

Through state and federal funding, as extension of community-based health centers in Boston, Massachusetts has reached twenty-six branches in addition to its abundance of hospitals. These clinics are not only located in the state capital, but they have become an integral part of many urban communities in Massachusetts in response to the recognized demand for medical attention. In fact, until the Brockton Neighborhood Health Center was established, Brockton was the only community of its size, in area and in population, without a neighborhood health center.

Thus, with the success of coin munity-based health centers statewide, the proposal of such a clinic in Brockton was developed. However, with the election of Mayor Winthrop Farwell Jr., the center faced definite obstacles. The center was being proposed and supported by a consortium consisting of Cardinal Cushing9 General Hospital of Brockton, Goddard Memorial Hospital in Stoughton, New England Sinai Hospital in Stoughton, the Cranberry Specialty Hospital in Middleboro and Brockton Area Multi- Services. The consortium was one of307 to apply for funding from the Federal Bureau of Primary Care as anew or expanding facility. On September 25, 1992, the federal government awarded a $289,447 per year “start-up” grant for the proposed Brockton Neighborhood Health Center. With this, a Board of Trustees had to be formed to receive the funds and to- , oversee the establishment of the facility. The president of this board was Judith Kubzanski who also worked as chief executive officer at the Cranberry Specialty Hospital in Middleboro. Two weeks later, Mayor Farwell learned that his Human Resources administrator, Robert A. Martin, had written a letter to the Federal Bureaus of Primary Care in May 1992 in support of the neighborhood health center to be located in the downtown area. With this, Mayor Farwell suspended Martin for two days without pay for sending the letter without authorization from the mayor.

Once the health center was granted funding to situate the clinic, opposition to the clinic made their voice stronger. Two key critics of the health center were Councilor at Large Geraldine Creedon and City Councilor Joseph Kelley.

These city officials claimed that the efforts to establish a Brockton Neighborhood Health Center were ultimately a duplication of services, considering that Brockton already had three full-service hospitals in its jurisdiction. “With three hospitals, are we really underserved? I don’t see-a lack of commitment to serving the people we have here,” claimed Creedon. Also, in response to the federal grant, Kelley claimed that the Brockton Neighborhood Health Center “could not satisfy the medically underserved designation” without manipulation of data. “I believe this agency misled the federal government” so that they could qualify for the funding.
In response to the accusations, Judith Kubzanski reminded those city officials who were criticizing the enter that the medical data was not reflecting the status of Brockton on the whole but rather, it reflected the census tracts that showed need. While some city officials stood opposed to the health center, and particularly for its proposed location in downtown Brockton, others supported the idea. Namely, City Councilor Louis Angelo gave adamant support for the health center as well as its location in the downtown area. Angelo stated, “Neighborhood health centers work in every other city. I don’t see why it can’t work in Brockton.” Furthermore, even directors of health centers in Boston questioned the extent of medical services available in Brockton. This curiosity stemmed from the fact that an impressive number of Haitians and Cape Verdeans, Brockton’s two largest immigration groups, had been traveling to either the Mattapan neighborhood Health Center or the Codman Square Neighborhood Health Center in Dorchester for medical care.

With the increasing support of the health center, those in opposition specified their concerns and arguments. Opponents could not deny that the Medically Underserved Area of Brockton was in need of a primary and preventive clinic. However, the issue became branched around the siting of the health center. Abiding by the requirements of the Federal Bureau for Primary Care, the neighborhood health center selected three possible sites within the Medically Underserved Area.

The first of these possible sites for the health center was the former site of Christy’s Market on the corner of Main and West Elm Streets. This location was investigated early in 1992 and when the idea was announced, the supporters of the health center faced overwhelming refusal by city officials and the owners of downtown businesses. Since the consortium at that time lacked the support and specifically political force to fight the refusal, it had to seek out an alternative site. The second site, chosen as an alternative was the former General Electric Building on Warren Avenue, also considerably near the downtown area. The third site was proposed for One North Main Street, which lies outside of downtown Brockton yet within the area designated as Medically Underserved. Ironically, when Mayor Farwell heard about this third site on North Main Street, he shifted his stance concerning the health center. According to an article in the Brockton Enterprise on Friday, November 13, 1992, “Farwell told center supporters that he would approve a site outside the business core of downtown as long as the ward councilor supports it.” For the Board of Trustees for the Brockton Neighborhood Health Center, this was a big step in the success of the clinic because, with the Mayor’s public support, the odds of approval by the City Council were on their side. However, board members particularly wanted the center to be located in the downtown area, more central to the Medically Underserved Area.